Purpose The purpose of this chapter is to present our initial results of the use of a hybrid operating room (OR) in cerebrovascular procedures. Methods In this retrospective study, 152 patients who suffered from cerebrovascular pathology and were treated at the hybrid OR at the Department of Neurosurgery at Kepler University Hospital from April 2020 to October 2022 were included. Vascular pathologies and hybrid interventions were analyzed. Additionally, the number of residual aneurysms and vessel stenosis/occlusions was assessed. Results Specifically, 106 patients were treated because of a cerebral aneurysm. In six cases, a residual aneurysm was identified. In another three cases, a stenosis/occlusion was found, and in three patients, a hybrid intervention was performed. These results indicate that about 10% of the patients might benefit from the treatment in a hybrid OR. Furthermore, 49 patients were treated for carotid stenosis/occlusion and 12 had an arteriovenous malformation or fistula. Conclusion No procedure-related complications occurred in the observed cohort. The hybrid OR provided readily available, high-quality intraoperative imaging. Hybrid procedures increase the quality of care and patient safety. Furthermore, they might contribute to the reduction of intraoperative complications.